RT Book, Section
A1 Hoyer, Dieter Paul
A2 Molmenti, Ernesto Pompeo
A2 Santibañes, Martin de
A2 Santibañes, Eduardo de
SR Print(0)
ID 1180108641
T1 Deceased Donor Evaluation
T2 Liver Transplantation: Operative Techniques and Medical Management
YR 2021
FD 2021
PB McGraw Hill
PP New York, NY
SN 9781260462517
LK accesssurgery.mhmedical.com/content.aspx?aid=1180108641
RD 2024/04/24
AB Cerebral  swelling  after  brain  injury  is  a  common  phenomenon.The  fixed  volume  of  the  human  skull  results  in  increased  intracranial  pressure.Brain  perfusion=function  of  mean  arterial  pressure  minus  intracranial  pressure.Increase  of  intracranial  pressure  has  to  be  accompanied  by  an  increase  of  mean  arterial  pressure  to  preserve  brain  perfusion.The  brainstem  contains  baroreceptors  issuing  activation  of  the  autonomic  nervous  system  and  releasing  catecholamines.During  cerebral  swelling  and  brain  death,  catecholamine  levels  can  be  observed  up  to  20-fold  of  normal  values.Consequently,  such  a  catecholamine  storm  leads  to:Dramatically  increased  systemic  blood  pressureSubintimal  hemorrhage  in  the  arteries  (particularly  at  bifurcations)  with  a  risk  of  thrombosisMicrocirculatory  perfusion  defects  due  to  increased  macrovascular  tensionBrain  herniation  and  coning  lead  to:Hypotension  and  vasodilationFailure  of  hormonal  and  neural  regulators  of  vascular  toneCessation  of  antidiuretic  hormone  (ADH)  secretion  (diabetes  insipidus  and  hypernatremia)Failure  of  the  hypothalamic-pituitary  axis  (steroids,  thyroid  hormones,  etc.)